Implant feels heavy and sagging on one side

Question

I am 6 years post bilateral mastectomy with implant placemant. I recently had them both replaced due to rupture implant. Before they were replaced, i began having a heavy sagging feeling on my left implant. Annoying feeling when bra is off. After implant replacement surgery the feeling came back and i think the implant looks like it sags moe compared to the other that feels normal. My surgeon didnt have any answer why this may be, so wondering if anyone else might have an idea? Thank you

Randal Haworth, MD, FACS · Answer

It's understandable that you are concerned about the heavy sagging feeling and the apparent difference in appearance between your left and right breast implants. While I can't diagnose or provide a specific reason for your symptoms, I can suggest a few possibilities that you might want to discuss with your surgeon:

-Capsular contracture: Capsular contracture is a potential complication that can occur after breast implant surgery. It happens when the scar tissue capsule around the implant becomes tight or contracts, causing the implant to feel firm and potentially change in shape or position. Capsular contracture can lead to discomfort or asymmetry. It's possible that the heavy sagging feeling and appearance you're experiencing could be related to this condition.
Implant malposition: If the implant is not positioned correctly or if there is a pocket-related issue, it can result in asymmetry and a sensation of sagging. This may occur due to factors such as inadequate tissue support or surgical technique.

-Implant size or shape: If there is a significant difference in the size or shape of the implants used, it could contribute to the perceived sagging or asymmetry. It's possible that the new implant used during the replacement surgery may not match the original implant's characteristics, resulting in a noticeable difference.

-Natural breast changes: Over time, natural breast changes, such as tissue laxity or changes in skin elasticity, can affect the appearance and feel of breast implants. These changes might become more noticeable following implant replacement surgery.

Given your concerns and the persisting symptoms, it would be best to consult with your surgeon or a qualified plastic surgeon who specializes in breast reconstruction or revision surgeries. They can evaluate your specific case, examine your breast implants, and provide you with a more accurate assessment. Additional imaging tests, such as an ultrasound or MRI, might be recommended to gather more information about the implant and surrounding tissues.

I hope this helps,
best of luck !

Michael A. Fallucco, MD, FACS · Answer

Thank you for sharing your experience, this is a common and understandable concern after implant reconstruction.

That persistent heavy, sagging feeling you describe in the left breast, especially noticeable without a bra can sometimes be due to pocket laxity, asymmetry in implant positioning, or weakened support from the surrounding tissue. After a mastectomy and implant placement, particularly over time, the skin and internal support structures (like the capsule or muscle) on one side can stretch more than the other, leading to a "bottomed-out" or lower-positioned implant. Even after implant replacement, if the underlying pocket wasn’t revised or tightened during surgery, the same issue can recur.

Another possibility is capsular stretch or thinning of the soft tissue envelope on that side. This can happen after implant rupture, as the body responds differently to leaked silicone and may lead to changes in tissue integrity over time.

If your surgeon didn’t note any complications during the replacement surgery but you still feel and see a difference, you might consider a second opinion from a plastic surgeon who specializes in complex breast revision. Imaging (like ultrasound or MRI) and a clinical exam can help determine whether the implant has dropped, rotated, or if the pocket needs surgical adjustment (e.g., capsulorrhaphy or internal mesh support).

In short, what you're experiencing is not uncommon, and while your implants are new, the surrounding tissue and pocket dynamics may need to be addressed to restore symmetry and comfort. You deserve to feel balanced and at ease, don’t hesitate to explore your options.

Jeremy Powers, MD · Answer

Thank you for your important question. After an implant based reconstruction, the implants will continue to change over time, and are subject to the same forces of gravity that affect everything else in our bodies as we age, leading to areas that sag and drop. How much that affects your implant reconstruction depends on several things - is the implant above the muscle or under the muscle (partially or totally). Implants partially under the muscle tend to get pushed downwards and towards the side over time due to normal pectoralis muscle activity. Implants above the muscle have only the skin supporting them, and any dermal matrix or mesh that your surgeon used at the time of placement. But the skin and the dermal matrix products still stretch over time. 
What is not clear is why you developed the feeling of heaviness on one side only. Perhaps there really is more sagging on that side and because its sagging more it is pulling on the tissue / nerves more, and thus you feel it more on that side. Does the sagging feeling go away when you support the breast with your hands or a bra? If so, that would be a good indicator that supporting the implant with a more sturdy “internal bra” mesh may help the feeling to go away. There are some mesh products that are stronger/more permanent than others and potentially should be used in a revision in your case. If the feeling doesn’t go away when you support the implant externally, them I’m not sure that an additional surgery will help, apart from certainly trying to make it look better compared to the other side. 
There is also the consideration of the size of the implant, the profile of the implant, and whether it is silicone or saline filled. Most likely for reconstruction you have a silicone gel implant. I would also wonder whether you’re having this problem on the cancer side or the prophylactic mastectomy side. This is surgeon dependent, but I have observed that sometimes the mastectomy is done slightly differently, on the prophylactic side compared to the cancer side. For example, more of the inframammary fold supporting fascia could have been taken on the cancer side versus the prophylactic side, leading to more issues on the cancer side with supporting the implant reconstruction over time. Of course, the mastectomy has been done long ago and it is still up to the plastic surgeon to address these factors and optimize the aesthetic result after mastectomy.

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